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BIRTH DEFECTS EPIDEMIOLOGY AND 21.03.2017¢  BIRTH DEFECTS EPIDEMIOLOGY AND SURVEILLANCE Peter Langlois,

Sep 13, 2019

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  • BIRTH DEFECTS EPIDEMIOLOGY AND

    SURVEILLANCE

    Peter Langlois, PhD, Senior Scientist

    Birth Defects Epidemiology and Surveillance Branch

    Texas Department of State Health Services

  • Outline

    • Texas birth defects registry

    – Overview

    – Describing the occurrence of birth defects

    – Cluster investigations

    • Some research on causes of birth defects

    • Zika virus and microcephaly

  • Texas Birth Defects Registry: Overview

  • History

    1991 Headlines

  • The Texas Birth Defects Registry: What It Is

    • One of the largest active birth defects surveillance systems – Passive vs. active surveillance

    • Extensive quality control checks – Includes review of roughly 50% of records by

    clinical geneticists

    • Computerized database of infants and pregnancies affected by birth defects

  • The Texas Birth Defects Registry: Case Definition

    • Infant/fetus has structural or chromosomal anomaly

    • Mother resident in TX at delivery

    • Birth defect diagnosed prenatally or within first year of life

    • Includes all pregnancy outcomes

  • The Texas Birth Defects Registry: What It Does With The Data

    • Describe occurrence of birth defects in Texas

    • Conduct cluster investigations

    • Work with others in: – Research

    – Prevention

    – Linking families to available services

  • Texas Birth Defects Registry:

    Describing the Occurrence of BDs by Time, Place, and Person

  • Birth Prevalence of Children With Any Monitored Birth Defect by Year

    0

    100

    200

    300

    400

    500

    600

    700

    1999 2001 2003 2005 2007 2009 2011 2013

    C a s e s p

    e r

    1 0 0 0 0 l

    iv e b

    ir th

    s

    Birth Year

  • The Increase May Be Due Largely to Better Detection/Ascertainment Over Time

    Average Annual % Change

    Birth Defect Category All Cases Isolated Cases

    Least Susceptible to Diagnostic Variability

    e.g. gastroschisis, limb reduction defects

    - 0.2 - 3.8

    Somewhat Susceptible

    e.g. hypospadias, trisomy 21

    + 0.5 - 2.7

    Mid Susceptibility

    e.g. anotia/microtia, tetralogy of Fallot

    + 1.4 - 0.4

    Quite Susceptible

    e.g. VSD, renal agenesis/dysgenesis

    + 0.8 + 3.1

    Most Susceptible to Diagnostic Variability

    e.g. ASD, cataract

    + 2.0 + 2.9

  • Birth Prevalence of Children With Gastroschisis by Year

    0

    1

    2

    3

    4

    5

    6

    7

    1999 2001 2003 2005 2007 2009 2011 2013

    C a s e s p

    e r

    1 0 0 0 0 l

    iv e b

    ir th

    s

    Birth Year

  • Ambient Levels of Benzene and Spina Bifida, Texas 1999-2004

    Benzene Level (ug/m3) Adj Odds Ratio (95% CI)

    0.12 – 0.45 1.00 (referent)

    >0.45 – 0.98 1.77 (1.04 - 3.00)

    >0.98 – 1.52 1.90 (1.11 – 3.24)

    >1.52 – 2.86 1.40 (0.82 – 2.38)

    >2.86 – 7.44 2.30 (1.22 – 4.33)

    Lupo PJ et al. 2011 Environmental Health Perspectives

  • Proximity of Children with Birth Defects to Pediatric Genetics Clinics, Texas, 1999-2003

    Represents 22,875 cases from the Texas

    Birth Defects Registry delivered 1999-2003

    Case AP et al. Birth Defects Research Part A 82.11 (2008)

  • Prevalence of Down Syndrome (Trisomy 21), by Maternal Age, Texas, 1999-2007

    0

    20

    40

    60

    80

    100

    120

    140

  • For your own queries: http://healthdata.dshs.texas.gov/Registries/BirthDefects

    http://healthdata.dshs.texas.gov/Registries/BirthDefects

  • Texas Birth Defects Registry:

    Cluster Investigations

  • Birth defect cluster

    One definition: more than the expected number of cases of a birth defect in a population group for a defined geographic area and a defined time period

  • What causes birth defect clusters?

    • Chance…normal fluctuation over time in the occurrence of birth defects

    • Changes in diagnostic practices or hospital referral patterns

    • Shared exposure the cases have in common

  • Why investigate birth defect clusters?

    • Generate new clues about causes of birth defects (RARELY)

    • Respond to the concerns of community members

    • Educate/inform the public about birth defects

  • A Recent Cluster Investigation: Trisomy 18

    In the Bryan/College Station Area

     Cluster of 4 babies conceived during August 2009–February 2010 to residents of Brazos County  2 families from Bryan

     2 families from College Station

     Concern about possible relationship to chemical plant fire on July 30, 2009

  • Trisomy 18 by Estimated Date of Conception

    0

    1

    2

    3

    1 9

    9 8

    J an

    1 9

    9 8

    J u

    l

    1 9

    9 9

    J an

    1 9

    9 9

    J u

    l

    2 0

    0 0

    J an

    2 0

    0 0

    J u

    l

    2 0

    0 1

    J an

    2 0

    0 1

    J u

    l

    2 0

    0 2

    J an

    2 0

    0 2

    J u

    l

    2 0

    0 3

    J an

    2 0

    0 3

    J u

    l

    2 0

    0 4

    J an

    2 0

    0 4

    J u

    l

    2 0

    0 5

    J an

    2 0

    0 5

    J u

    l

    2 0

    0 6

    J an

    2 0

    0 6

    J u

    l

    2 0

    0 7

    J an

    2 0

    0 7

    J u

    l

    2 0

    0 8

    J an

    2 0

    0 8

    J u

    l

    2 0

    0 9

    J an

    2 0

    0 9

    J u

    l

    2 0

    1 0

    J an

    2 0

    1 0

    J u

    l

    C as

    e s

    Brazos County

    0

    1

    2

    3

    1 9

    9 8

    J an

    1 9

    9 8

    J u

    l

    1 9

    9 9

    J an

    1 9

    9 9

    J u

    l

    2 0

    0 0

    J an

    2 0

    0 0

    J u

    l

    2 0

    0 1

    J an

    2 0

    0 1

    J u

    l

    2 0

    0 2

    J an

    2 0

    0 2

    J u

    l

    2 0

    0 3

    J an

    2 0

    0 3

    J u

    l

    2 0

    0 4

    J an

    2 0

    0 4

    J u

    l

    2 0

    0 5

    J an

    2 0

    0 5

    J u

    l

    2 0

    0 6

    J an

    2 0

    0 6

    J u

    l

    2 0

    0 7

    J an

    2 0

    0 7

    J u

    l

    2 0

    0 8

    J an

    2 0

    0 8

    J u

    l

    2 0

    0 9

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    2 0

    0 9

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    l

    2 0

    1 0

    J an

    2 0

    1 0

    J u

    l

    C as

    e s

    Surrounding Counties

    Fire, 7/30/2009

  • Some Research on Causes of Birth Defects

  • Texas Center for Birth Defects Research

    and Prevention, 1996-2013

    Cooperative agreement grant with CDC

    One of 10 centers in the nation

    National Birth Defects Prevention Study

     Largest population-based case-control study on birth defects to date

     Study includes 30 specific birth defects

     Additional clinical review and classification of cases

     Computer-assisted maternal phone interview

     Cheek cell samples (DNA): mom, dad, infant

  • Pre-pregnancy Obesity and Selected

    Isolated Birth Defects, 1997 – 2002

    0

    1

    2

    3

    AN SB HYD A/M CP CLP Ano HYP LIM HEA OMP GAS

    Waller DK et al. 2007. Archives Pediatr & Adolesc Med

    aOR

  • Fever, Antipyretics, and Oral Clefts,

    1997-2004: Adjusted Odds Ratios

    _I: Isolated defects; _M: Multiple defects

    Hashmi S. 2010. Birth Defects Research Part A

  • Zika Virus and Microcephaly

  • Current Zika Virus Outbreak

    • Fall 2015: NE Brazil reported a twenty-fold microcephaly increase that coincided with local transmission of Zika virus

    • February 2016: World Health Organization declares Zika to be a global Emergency

    • August 2016: First cases of Zika virus infection locally spread by mosquitos in continental US

  • Reported occurrence of Aedes aegypti & albopictus

    by county in the United States

    Maps showing the reported occurrence of Ae.

    aegypti (A) and of Ae. Albopictus (B) by

    county between 1 January 1995 and March

    2016 in the United States.

    Micah B. Hahn et al. J Med Entomol

    2016;jme.tjw072

    A B

  • Definition

    •Clinical finding of a small head (when compared with infants of the same sex and age).

    •CONGENITAL MI